Went to the urgent care the other day because of a high temp over a few days, lots of fussiness, lack of eating and when she does eat she would vomit. They did all the normal things like checking weight, temp, looking in ears and throat. The conclusion was "take fever reducers and here is a prescription for medicine to help with nausea".

My wife asked about any infections, specifically, UTI's, because she was playing in sand in Florida for the past few days. The doctor said they don't like to do the urine test, because, well, it means a catheter to get the urine and they only do it if there was a past UTI.

Long story short we opted for the urine test and she did have an infection and it was probably the cause for the fever. And it's only by luck that we know. I, for one, am going to want a urine test no matter what but should everyone ask for that? What other tests that are "optional" should parents be asking for if they find themselves at the urgent care with a fussy, high temp child?

3 Answers
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I'm assuming that your daughter is very young--not quite 1 yet maybe? Older children are usually capable of giving a urine sample, so if they had to use a catheter then obviously she's not old enough to do that, yet.

In small children, fever, vomiting, and general crankiness can be the only signs of a UTI. They can also be signs of gastroenteritis, which, at this time of year, is ridiculously more common in young children than UTIs are (my son had a 24-hour one last night/today, for example). If your daughter had had gastroenteritis, the doctor's initial recommendation would have been perfectly acceptable.

Unless you think your daughter is going to be having UTIs frequently, asking for her to be catheterized whenever you need to go to urgent care might be a little extreme--especially if it's obvious she has, say, an ear infection or strep throat. My children have never had to be catheterized for anything, but I have friends whose children have had to be catheterized for UTI testing, and, from what I understand, it's pretty miserable and somewhat invasive. In other words, it's probably not something you'd want to do unless you had to. I've had to be catheterized a few times and didn't especially enjoy it and I was an adult. But now that your daughter has had 1 confirmed UTI, it would certainly be easier to convince a doctor to test her for one if you find their initial conclusion unsatisfying and she has the same symptoms.

If your daughter keeps presenting with UTIs, she may need to be assessed by a pediatric nephrologist as there could be an underlying medical problem causing the infections. I've done some searching and I can't seem to find any reported connections between playing in the sand and urinary tract infections, but I'm not a doctor.

As for other tests/diagnostics you could request anytime you go to the doctor (not necessarily urgent care):

X-rays: Obviously most commonly used to assess broken bones, but chest x-rays can be helpful if you/doctor suspect something like pneumonia.

Blood cultures: For bacterial infections. They usually only like to do blood cultures if a child is fairly ill--it does involve drawing blood which can be difficult in small children. It also takes a couple of days to get results.

Urine cultures: Similar to blood cultures, but for urine instead. If there is concern that the bacteria causing a UTI could be antibiotic-resistant or simply not respond well to standard treatment, doctors will sometimes do a culture to determine the type of bacteria causing the infection.

Flu test: If you or your doctor suspect your child has or is coming down with the flu. This is especially helpful if you catch the illness early and your child can take Tamiflu, but you have to catch it within the first 48 hours of flu symptoms, I believe.

Throat swab: Usually to test for strep, but a throat swab can also test for Mono. It's not practical or reasonable to perform either of these tests if your child does not have a sore/red throat or swollen lymph nodes. They're two separate tests, but I've had both of them run on me in a single office visit and had results returned very quickly (10 minutes or less).

Those are the tests I can think of that would be considered more or less "standard" offerings at an urgent care clinic or pediatrician's office. Other, more non-standard diagnostics, like ultrasounds, would probably need to be performed elsewhere.

As an aside, we've recently seen an up-tick in pediatric after-hours clinics in our area which are super nice because they only see children. Don't underestimate how awesome it is for you to go somewhere with your child that only specializes in children.

This is advice based on adult experience, so take it with a grain of salt: I was catheterized once briefly (just in and out, to help me void my bladder while I was giving birth) and was told to watch out for UTI signs after, because catheters can cause a UTI. So if I were you I would not ask for it routinely.

+1 for catheters posing a risk of UTI. My wife was catheterized the day after giving birth. The day we came home from the hospital, my wife had to go right back because she had developed a UTI from the catheter. It probably didn't help that an intern performed the procedure, but my son and I wound up spending his first night at our house without my wife because of it.
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BeofettNov 20 '13 at 13:11

There is also a small risk of urethra puncture, which I expect would be higher in a small child.
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MJ6Nov 20 '13 at 14:54

It's unlikely you would have never known except by "luck." The worst case is the fever still doesn't break after a few days, so you go back in and they run more tests. You know your child better than any doctor. You followed your instincts and it worked out.

However, they can't test for everything all the time. They have to go with what is most likely under the circumstances, and often the treatment is the same. The last time my daughter went to the hospital with a high fever, it turned out she had meningitis, but you don't want to ask for a lumbar puncture every time. The last time I went to the hospital with a high fever, I had a rare tick-borne disease called ehrlichiosis, but it's not something to regularly test for.

Knowing that your daughter is prone to UTIs, you still don't necessarily need to get the test every time. With the history and if the symptoms fit, you can often convince a doctor to treat it without an invasive test.